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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209133
Report Date: 08/23/2021
Date Signed: 08/24/2021 09:30:12 AM

Document Has Been Signed on 08/24/2021 09:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PATHWAY HOMESFACILITY NUMBER:
157209133
ADMINISTRATOR:JOHNSON, JASONFACILITY TYPE:
740
ADDRESS:2717 GOSFORD RD #ATELEPHONE:
(661) 972-6235
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 0DATE:
08/23/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jason Johnson, LicenseeTIME COMPLETED:
10:30 AM
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On 8/23/21 at 10:00 AM, Licensing Program Analyst (LPA) Malia Thao conducted a follow-up Prelicensing inspection. LPA was completing a prelicensing inspection for #157209157 and asked if Licensee was ready to conduct the follow up for this facility. Licensee stated yes.

LPA measured hot water in the hall bathroom to be 107.4 degrees F. LPA observed furniture in bedroom #2 to be sufficient for 2 ambulatory residents. Licensee understands if a bedridden resident is residing in bedroom #2, only one bed will be made available in the bedroom allowing no obstruction to fire exit door.

All pre-licensing requirements have been met. LPA will notify CAB in Sacramento for final review prior to license being issued.

Exit interview was conducted. A copy of this report was emailed to Licensee Jason Johnson at pathwayhomes@yahoo.com with a read receipt to confirm receipt of this report.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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